The present disclosure is related to computer operated devices for controlling the ordering, dispensing, issuing and administration of medical items including drugs and supplies for patients.
There currently exists a number of devices that may be used in a healthcare setting for controlling the ordering, dispensing, and administration of medical items, including drugs and supplies, under the control of a computer. Performing such functions under the control of a computer allows data to be gathered that can be used for billing, reordering of stock as well as creating an audit trail. Such devices include, for example, imaging devices for inputting new prescriptions or new orders for patients into a central pharmacy system, computer controlled dispensing cabinets, hand held scanners that can be used for bedside administration of drugs, and open bins of supplies having a local computer into which information relating to the issuing of supplies for patients can be logged. Such devices can be purchased from a variety of vendors.
Some devices, such as the handheld bedside scanners, require a substantial investment in infrastructure which may create a bather in the sales process. In U.S. patent application Ser. No. 09/998,121 filed Nov. 30, 2001 and entitled Method Of Issuing Medical Supplies And Dispensing and Administering Medications Through A Hand-Held Device And System For Doing The Same, which is hereby incorporated by reference, the assignee of the present invention has proposed integrating into their handheld bedside scanner the ability to issue medical supplies from open bin storage shelving. However, the investment in such infrastructure is not currently being fully leveraged to provide advantages for other devices used by nurses such as the imaging devices and computer controlled cabinets.
From the user's point of view, integrating into one device the ability to dispense medications, issue supplies, and administer dispensed medications seems convenient, but the underlying infrastructure and rules applicable to each of these processes makes integration difficult. For example, medications are typically dispensed by a pharmacy. The pharmacy may be set up using a centralized dispensing model, decentralized dispensing model, or a combination of the two. In each of the three models, various combinations of automated (e.g. unit based dispensing cabinets), partially automated (e.g. carousels), or manual (e.g. open shelving) equipment may be used. As medications are dispensed, counts must be maintained to insure that the pharmacy does not run out of the needed medications. Counts may be maintained automatically in computer controlled devices, manually, or a combination of both. Provision must also be made to accommodate returned medications that have been dispensed for a patient but have not been administered, e.g. the patient has been discharged, prescription has been changed, etc.
The pharmacy must also be capable of interaction with other systems. For example, the pharmacy is responsible for communicating with insurance companies or clearing houses to determine if a patient's insurance allows for substitution and, if so, what are the allowable substitutes, as well as to determine what the patient's insurance will pay for. The pharmacy system must interface with the healthcare facility's billing system and systems for reordering medications.
As might be expected, the pharmacy is governed by various rules. For example, in all cases, except certain emergency situations, medications dispensed for a patient must be reviewed by a pharmacist. Rules may be in place that require each prescribed medication to be cross-checked for interactions with other medications ordered for the patient and to be checked against known patient allergies. The pharmacy may also be responsible for tracking the age and lot numbers of medications to insure that expired medications and recalled medications are quickly removed from the distribution chain. When one considers that a pharmacy must perform all these functions and follow all these rules for perhaps thousands or even tens of thousand of prescriptions a day, it is easy to understand that the operation of a pharmacy has become a complicated and specialized process.
In addition to dispensing drugs for administering to a patient, a nurse or other healthcare worker may also need to have supplies issued for a patient. Supplies are typically controlled by a materials management department within a healthcare facility. Supplies typically are not regulated as are medications and therefore materials management departments often do not need to follow the same strict rules that are applicable to pharmacies. Nevertheless, the materials management department must be able to keep track of current inventories to insure that all needed supplies are on hand. That can be a daunting task for several reasons. First, there may be thousands of items in inventory. For each item, that item may be available from various suppliers at different prices with each supplier using its own unique stock number. Also, supplies are often kept in open bins or shelving. When items are removed, it is up to the user to remember to document the items' removal. Often times, such documentation is not performed, and items can be low or out of stock without the materials management department learning of such situations until a manual count is performed. The materials management department must interact with the healthcare facility's billing system and supplier's systems for reordering supplies.
The nursing function is one way that the healthcare facility interacts with patients. Nurses dispense medications for patients, either from a centralized or decentralized pharmacy. Nurses also issue supplies for patients. It can be time consuming to dispense all the necessary medications and issue all the necessary supplies for each patient on the current round for that nurse as medications and supplies are not kept in the same storage locations, and both medications and supplies may not be where they are supposed to be located. Also the procedures for dispensing medications are different than the procedures for issuing supplies. For example, the procedure for dispensing a medication from a unit based cabinet is very different from the procedure for issuing a supply from open bins. Finally, the administering of medications to a patient is strictly governed by rules, whereas the delivery of supplies to a patient is not. The administration of medications must insure that the right patient, receives the right dose of the right drug, via the right route, at the right time. The administration process must also be documented to create an audit trial. Thus, in addition to tending to the needs of patients, a nurse must be aware of a variety of different dispensing and administering schemes for drugs as well as issuing and delivery schemes for supplies.
Nursing has identified certain problems in dispensing schemes utilizing computer controlled dispensing cabinets. One problem is nurses taking central pharmacy dispensed medications from a patient specific cassette for another patient that is assigned to another nurse. In such situations, medications cannot be found where they are expected to be. Another problem is that nurses waste time waiting in lines at computer controlled dispensing cabinets at peak times. It would save significant time if nurses could either get all their medications in one place or if they knew exactly where to go to get the medications they needed. Existing infrastructure could also be leveraged if additional functionality could be added to devices currently being used for other functions.